DESCRIPTION The Pathways Project is a comprehensive, school-based intervention designed to help reduce obesity in Native American children. Grades 3, 4, and 5 in forty schools from six American Indian nations are involved: Pima/Maricopa, Tohono O'odham, Navajo, White Mountain Apache, Oglala Lakota, and Sicangu Lakota. The intervention is implemented through representatives of the six nations and four cooperating universities: The Johns Hopkins University, the University of New Mexico, the University of Arizona, and the University of Minnesota with a fifth institution, the University of North Carolina, serving as the Coordinating Center. The design of Pathways is a randomized, controlled trial with the following components: physical activity, food service, classroom curriculum, and family involvement. The NHLBI funded a three-year feasibility study, whose results are summarized in the proposal, and now the PI's are requesting funding to begin the full-scale study, to be carried out over a five-year period. SIGNIFICANCE The purpose of this study is to develop a comprehensive program that is school-based to promote healthy eating behaviors and increased physical activity in American children. The specific aim is to decrease the prevalence of obesity in American Indian children. The major outcome variable is percent body fat after three years of intervention. The investigators have documented that American Indians have a higher prevalence of obesity. In addition, when examining the NHANES II and HHANES-MA national reference sets, American Indian children have significantly higher BMIs for nearly every age and sex group. By defining overweight as exceeding the 85th percentile of the reference population, American Indian children have 39% compared with the NHANES-2 population and 28.6% compared with the HHANES-MA population. The investigators selected the strategy of intervening in school children. They have selected grades 3, 4 and 5 since developmental age appears to be critical for learning health knowledge and skills. They refer to other studies which have tried programs in older children and adolescents with a very low rate of success.